Egg freezing delivers lower take-home baby rate

The number of IVF procedures carried out in Malta in 2015 might have increased by 82.9% over the previous year, but there was a drop of 0.52% in reported pregnancies out of all cycles started.

From the 311 IVF cycles carried out in 2015, there were 8% of couples who had a live birth, 10.9% who are still expecting, while 9.3% of couples miscarried, for a maximum percentage take-home baby rate of 18.9%. Despite registering an increase over the previous year, when the live-birth rate stood at just 8%, the results are well below the European average of 30%.

And that has critics of Malta’s egg freezing technology, which is offered on the national health register, unhappy.

Labour’s women’s section, which actively supports the ministry for health’s proposal to introduce embryo freezing as part of the state-funded IVF service, yesterday said IVF laws had to reflect a reality that has been ignored.

Claudette Abela Baldacchino: Labour’s womens section is vocal on embryo freezing but a PL majority could be lacking

“Our appeal is for the government to move forward and embrace recommendations submitted to the inter-ministerial IVF Review Working Committee made up of professionals from the ministries of health, social dialogue and civil liberties, and justice an culture,” Nisa Laburisti’s Claudette Abela Baldacchino said.

The PL’s women’s section is a vocal supporter of embryo freezing as well as anonymous donation of eggs and sperm. But the problem for Joseph Muscat’s government lies within the ranks of his own Labour parliamentary group, where he cannot rely on his comfortable seven-seat majority because of opponents to embryo freezing.

Last year Muscat said his government would be pushing for legislative changes, primarily the introduction of embryo freezing to increase IVF success rates, however no amendments have been discussed in Parliament yet, with a number of government MPs publicly stating they oppose such moves.

The 2015 annual report by the Embryo Protection Authority however notes that the regulatory body has proposed changes to reflect the outcomes of current regulations and recent judgements of the European Court of Human Rights. 

In fact, the authority itself noted that egg freezing – or cryopreservation – was less effective than fresh treatments, with a larger number of embryo transfers, pregnancies, and live and expected births reported from fresh cycles vis-a-vis thawed cycles. That means that when it comes to implanting sperm in a freshly harvested egg, it is more likely to deliver a pregnancy and live birth than when using additional eggs frozen for a future cycle.

The number of IVF procedures increased considerably over the past years. In 2015 there were 311 cycles performed, compared to the 170 and 100 carried out in 2014 and 2013 respectively. 

This increase appears to be reflective of the introduction of government-funded cycles which have been carried out at the assisted reproductive treatment clinic in Mater Dei Hospital since January 2015.

Out of 311 procedures carried out, 230 (73.95%) were fresh cycles; while another 80 (25.72%) were thawed cycles. One couple (0.32%) opted for a combined cycle, in which both fresh and thawed gametes were utilised.

62.9% of the fresh cycles were carried out at Mater Dei Hospital while the remaining 37.1% were held at private clinics.

In contrast, there were more thawed cycles carried out in the private sector (61.7%) than in the public sector (38.3%).

The law only allows doctors to implant two embryos in the mother’s womb at any one cycle, but the authority actually received 234 Additional Fertilization Requests (AFRs) with the majority of requests (74%) coming from the ART clinic at Mater Dei Hospital while the remaining 26% came from the private clinics. Of this total, 57.3% were approved on the basis of established criteria: a sign that Malta’s legislation is limited when it expects that all couples should only have two embryos implanted.

“The Authority ceaselessly receives requests by representative clinicians in both the private and public sector to consider the fertilization of three oocytes for specific couples, instead of the two permitted by law,” the EPA said.

State-funded IVF procedures up by 82%

306 procedures (98.4%) were undertaken by Maltese residents while the remaining five (1.6%) were undertaken by foreign couples who came to Malta specifically to perform the IVF procedure at one of the licensed private clinics. Despite efforts to attract medical tourism, the procedures carried out by foreigners dropped by 61% when compared to 2014.  

The number of IVF procedures carried out in Malta in 2015 increased by 82.9% over the previous year which may be mainly attributed to the fact that the ART Clinic at Mater Dei Hospital has started offering infertile couples IVF procedures free of charge as of January 2015.

Interestingly, out of the 311 cycles which were performed in 2015, 282 met the state-funding eligibility criteria, but only 176 of these were performed on the national healthcare system.

And 34% of those undergoing their first ever IVF attempt opted to self-fund the treatment, even though they were eligible for state-funded treatment. 

Couples eligible for state-funded IVF procedures are those suffering from primary infertility and secondary infertility, that is couples who have children from previous relationships, but not from current relationships.

Once again, the largest number (35.4%) of female patients undergoing IVF procedures this year was aged between 33 and 36. The second largest age group was between 29-32 years (25.1%), while 20.9% of female patients were in the 37-39 year old bracket. 

There were 12.2% of female patients aged between 40-42 years, while the remaining 6.4% were under the age of 29. 

In line with international figures the smallest number of couples referred for IVF procedures were those where the female is less than 29 years old.

Younger couples are advised to wait and try out other assisted reproductive procedures before resorting to IVF but this year, the regulator made an exception when a 24 year old woman was granted permission to undertake IVF procedures on medical grounds.